Posted on September 19, 2014
Source: Infection Control Today
Antiretroviral therapy (ART) is beneficial for the 5 percent to 10 percent of HIV-infected patients with reduced kidney function, although tenofovir – the most widely prescribed medication – should be avoided, recommend updated guidelines released by the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) and published in the journal Clinical Infectious Diseases
“Clinical Practice Guideline for the Management of Chronic Kidney Disease in Patients Infected with HIV” provides an update to guidelines last released in 2005, and notes that large studies conducted since then suggest tenofovir can lead to moderate kidney damage in some patients. The updated guidelines also recommend kidney transplantation as a viable option in HIV patients whose kidneys are failing.
Kidney disease is common in people with HIV – due to the virus itself, some antiretroviral and other medications, and a high prevalence of traditional kidney disease risk factors and other conditions, such as diabetes, hypertension, and co-infection with hepatitis C, says Gregory Lucas, MD, co-chair of the guidelines and associate professor at Johns Hopkins School of Medicine in Baltimore. HIV-infected people with kidney problems are at risk for kidney failure, called end-stage renal disease (ESRD). HIV-infected African Americans have a four- to five-fold increase risk of developing ESRD compared with HIV-uninfected African Americans. Additionally, even mild chronic kidney disease poses a substantially increased risk of cardiovascular disease and death.
“Research shows HIV patients who have clinically decreased kidney function are less likely to be prescribed ART, probably because physicians and other healthcare providers are concerned that many of these medications are cleared by the kidneys and don’t want to cause further harm,” says Lucas. “But the outlook for HIV patients with kidney disease is much better now that we have numerous effective treatments for HIV, many of which are not cleared by the kidneys.”
